Behind the Headlines with the Innovators: Strategizing Towards Total Quality at North Memorial HealthCare

Even as patient care organizations nationwide struggle forward on the journey towards the new healthcare—a U.S. healthcare system of improved care quality and patient safety, efficiency, cost-effectiveness, accountability, and transparency—the leaders of some pioneering organizations around the country are charting a bold, clear course. One of the organizations blessed with such leaders is North Memorial HealthCare, a two-community-hospital health system based in Robbinsdale, a suburb of Minneapolis-St. Paul, which encompasses the 300-bed North Memorial Medical center in Robbinsdale and the 100-bed Maple Grove Hospital.

Leaders there have launched themselves on a path that will position their organization beautifully to adopt the principles of the new healthcare, and it is one that is already reaping rewards. The core of what the leaders at North Memorial are doing is to leverage healthcare IT to facilitate enterprise-wide continuous quality improvement, not only for its own sake, but to achieve clinical transformation across diverse patient care service lines in the organization.

All the members of the leadership team provided HCI with extensive interviews. Below are excerpts from HCI Editor-in-Chief Mark Hagland’s interview with chief medical officer J. Kevin Croston, regarding the broad strategic initiative unfolding at North Memorial, and his perspectives on that initiative. Croston is a general surgeon by clinical background, and has been CMO for four years. Interviews with additional team members at North Memorial will be published online in the coming weeks.

Can you share with us the philosophy behind the continuous quality improvement that you and your colleagues are helping to lead, at North Memorial?

It’s a little more complicated than continuous process improvement; that is the ultimate outcome. But what we were trying to get to was that we have a medical staff with 300 employed physicians and 1,200 affiliated doctors. And we were really trying to migrate to become a real healthcare delivery system, not just a hospital.

J. Kevin Croston, M.D.

And the one thing we knew was that we needed to get significant physician buy-in; and people talk about being physician-led, but I didn’t think that would be a good plan, because just letting physicians lead, without a strategy, can engender battles. So we thought the idea would be to give the physicians the tools and then help them use those tools and lead change. And Health Catalyst, which was a spinoff of Intermountain Healthcare, came in and helped us build the data warehouse, and then helped us begin to look at the data and prepare to present it to the physicians.

So we created a working group, starting out with 10-12 physicians meeting once a week, with senior administrative leadership as well, charged with maintaining the quality of the system and prioritizing the different requests. And we began by choosing to look at women’s and children’s services first, because it was a high-dollar, high-value area.

And also a high-variance area?

Yes, high-variance and high-variability. And that’s where data is transforming things, because historically, you’d get doctors together, you’d present data, and then the doctors would spend the meeting telling us all the ways the data was flawed; and people would get frustrated, and then things would fall apart. Now, we’re sitting with the physicians and the data, and they’re telling us right away how to improve the data, and then they trust the data. And then they became change agents, rather than agents of inertia.

So once the physicians have been presented with the data and have made their suggestions and you adjust the data mechanisms, they now trust the data, with no pushback anymore, right?

Yes. One of our earliest projects was around the reduction of 39-week elective labor inductions, in order to improve outcomes for moms and babies. To begin with, you’d think that the concept of 39 weeks would be pretty straightforward, but we hadn’t even been recording the gestation carefully and correctly; estimated gestational time was not even being recorded in Epic. So we had to do work on that first, and standardize the definition and recording of gestational age. The data doesn’t mean anything if it’s not recorded in a standardized way.

What have been the biggest lessons learned, for you, as a CMO and as a senior clinician leader, in all this?

Probably a couple of things: one, physicians were viewed as both the problem and the answer in all these things. But the earlier we could engage them, the more they became part of the answer rather than the problem. Physicians want to improve, but they need to trust the data. And the second thing has been, just the power of reducing variation, and how empowering that is. When we standardized practice in the 39-week project, we lowered our NICU spend considerably; unfortunately, that savings